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Date posted: April 29, 2012

Dr Gyandas G Wadhwani

‘Fistula–in-ano’ is an inflammatory track which has an external opening (secondary opening) in the perianal skin and an internal opening in the anal canal or rectum, which is lined by unhealthy granulation tissue and fibrous tissue. It is classified as low level or high level fistula depending on whether the internal opening is below or above the anorectal ring respectively.

It usually originates from a perianal abscess in the inter-sphincteric space of the anal canal from infection of the anal gland; other causes include Ulcerative colitis, Colloid carcinoma of the rectum, Crohn’s disease, Tuberculosis etc. (the last 2 are associated with multiple fistulous openings, TB being more common in India)

Patients usually present with pain in the perianal region, fever, and/or discharge of pus which maybe bloodstained.

For recovery maintenance of proper hygiene is a must. Bowel habits can be improved to ease pain with intake of a high fiber diet and plenty of fluids. Sitz Bath for 10-15 minutes especially after defecation is soothing and promotes relaxation of anal muscles.

Surgical treatment(?) of the fistula is the only mode of treatment for the dominant school. John Henry Clarke has mentioned in his works that not infrequently it has been observed that surgical correction (or in-correction!) of the disease is often followed by chest ailments (Calc phos, Silica etc.) For the homoeopathic physician, it is a deep seated miasmatic disturbance which demands a homoeopathic similimum.

Our literature is rich in medicines for this condition like Calc phos, Silica, Nitric acid, Kali carb, Graphites, Mercurius, Fluoric acid, Sulphur, Syphilinum etc. each having its specific indication to be prescribed according to symptom totality.

We must go through the small but beautiful monograph ‘Fistula & Its Radical Cure’ by James Compton Burnett, in which he describes it as a disease fully amenable to internal medications.

I am forever indebted to Prof. L. M. Khan who as my Guru has taught me whatever little I know of homoeopathy and humbly submit that this disease is indeed completely curable with the indicated homoeopathic medicines chosen and prescribed as per the directions that Hahnemann laid down in Organon.

I share below 2 of my clinical successes:

Case no 1
Mr. A.M. 26 years old consulted us in April ’06. He was short with dark hair and eyes, a sharp nose with a prominent angle below the glabella, numerous black moles all over the body and trembling hands.

Presenting Complaints

  • Pain with discharge from the perianal region for about 1 year.
  • Low backache for 1 year.
  • Tendency to get pain in the right side of the abdomen with loose stools after eating out since childhood.

History
He was diagnosed as a case of right sided fistula-in-ano which was operated upon. Few months later he developed a left sided peri-anal abscess which too was surgically drained. For last 1 year again there is diffuse pain in the perianal region with discharge which is purulent, sticky and bloodstained. Associated itching and burning is present in the entire area.

Past Illnesses  

  • Twice had convulsions with high fever and diarrhea when 6-8 months old
  • Typhoid during school time with relapse
  • Chicken pox (severe) – 7 yrs back
  • Tinea cruris 2-3 times in the last 3-4 years (more often on right side) treated with topical antifungals 

Family Illnesses

  • Father: Piles
  • Mother: Asthma
  • Sisters: Carcinoma; Epileptic convulsions 

Personal History
Born in U.P.; in Delhi for the last 12 years; single, working and a vegetarian

Generals

  • Appetite: normal, can tolerate hunger
  • Thirst: good; likes cold water++
  • Desires: sweets++; ice cream ++; alcoholic drinks (vodka, beer) ++
  • Aversion: milk products++; brinjal & gourd
  • Bowels: normal, cleared once or twice
  • Urine: normal
  • Sleep: refreshing; on abdomen; salivation during sleep; thumb sucking during sleep as a child which still occurs occasionally
  • Dreams: numerous
  • Perspiration: profuse ++; on face; while awake
  • Thermal reaction: loves rains and cloudy weather+++; loves strong winds 

Life and Circumstances
He grew up watching fights and arguments between his parents all through; developed hatred for father because of his behavior towards his mother as he grew up- Never been able to come up with his feelings, his anger is pent up all inside him. Came to Delhi about 12 years back to pursue studies. He could not clear the MBA entrance exam after engineering and had to struggle to get a job. During the last 3-4 years he has got habituated to alcohol which he attributes to stress.

Mentals
His anger against his father was as palpable as soft corner for his mother. While talking about the situation at home he casually mentioned that he could not bear to see anyone in trouble and tried to do much as he could to help.

On examination

  • Abdomen: NAD
  • Respiratory system: normal breath sounds on auscultation
  • Peri-anal: fistula at 7’o’clock 

Prescription

14/4/06  Rx  Causticum L.M 1 B.D 

Analysis & Discussion
His sympathetic nature, love for rainy weather, right-sidedness of affections (both in fistula and tinea) and thirst for cold water formed the basis of prescription.

Follow up
Under Causticum (LM 1 to LM 5) he improved and his discharge decreased and was no more blood-stained. He now complained only occasionally of pain in buttocks and perianal region. Backache too became infrequent. But the tendency for pain in the right side of the abdomen with loose stools after eating out persisted.

17/6/06
The pain had decreased considerably but there was a milky white discharge almost every alternate day with accompanying itching off and on. Backache again became more prominent.

We had also observed that during all he visits he would call and confirm his appointment and yet reach much before the scheduled time. He also said that he would go to the washroom a number of times just to check himself even when he did not feel any discharge or discomfort. He also had a constant apprehension of something going wrong and would repeatedly ask ‘I will be alright doctor? I hope I don’t have to undergo knife again.’

He further disclosed that he was always nervous and restless before the exams.

Rx Argentum nitricum L.M 1 B.D

30/6/06 No pain at all; discharges absent; Backache-absent.

He received Argentum nitricum LM 2 – LM 4 B.D. and LM 5 -LM 9 O.D. and recovered completely. The fistulous opening closed and he could work more comfortably; his backache also vanished. Now he could tolerate food from restaurant more comfortably though too frequent eating out still caused indigestion.

He has been off medicines for last 1 year and reports doing well. For any trivial complaint he still receives placebo on telephone!

Case no 2
Mr. V.J., 24 years old first visited us in March ’07. He was obese and had dark hair and eyes, a dry pouting lower lip and was perspiring on nose and forehead. He was noticed sitting with his arms folded across his chest and he had eaten most of his nails.

Presenting Complaints

  • Discharge (often blood-stained) with pricking pain and itching from left sided openings in the perianal region for 1 year.
  • Pain in the perianal region (left side) for about 1 year.

History
It all started as a painful solitary eruption on the left buttock somewhere in summer ’06. Later it began to discharge pus and blood during defaecation or even anytime through the day with occasional itching. A surgeon diagnosed it to be fistula-in-ano at 3’0’ clock and 5’o’clock for which he took homoeopathic treatment (Silica, Flouric acid, Nitric acid etc.) without any relief.

Past Illnesses

  • Chicken pox in early childhood
  • Fracture (hairline) of Rt ankle twice in childhood
  • Monkeybite when 4-5 yrs of age
  • Left facial herpes zoster in august ‘06
  • Eosinophilia in November ’06. 

Family Illnesses

  • Father: lichen simplex chronicus
  • Paternal grandmother: cancer
  • Paternal uncle: HT & obesity
  • Paternal aunt: Brain tumor
  • Mother: asthma and piles
  • Maternal uncle: diabetes mellitus
  • Maternal grandfather: cancer and piles
  • Maternal grandmother: piles and allergic cough 

Personal history
Belongs to Delhi; is unmarried and working (in a BPO) with shift duties.

Generals

  • Appetite: normal
  • Thirst: normal
  • Desires: sweets++; warm food++; yellow butter+
  • Bowels: regular; occasionally hard stool
  • Urine: normal
  • Perspiration: profuse and easy; more when awake
  • Sleep: Disturbed; irregular sleeping pattern due to changing timings of office duties; on abdomen; occasional salivation
  • Thermal reaction: doesn’t tolerate extremes of temp well

Life and Circumstances
Youngest of three (2 elder sisters), he was born and brought up in a joint family background and grew up seeing his mother being ill-treated by his paternal aunts and overworking too. His father didn’t ever pay any heed to this and never supported or consoled her. Instead, he would discriminate between his own and his brother’s children, and was more inclined towards them.

Consequently he grew up with numerous insecurities which is reflected in his habit of nail biting, defensive sitting posture and tendency to sleep on abdomen. He couldn’t mix well with people and surroundings or make friends with ease all through his life.

Mentals
He is extremely touchy, defensive, insecure, nervous and short tempered. He is extremely particular about things; he also disclosed that his colleagues and associates often said that he was too high-headed and argumentative by nature.

On Examination

  • Abdominal examination: could not be done properly as he was extremely ticklish
  • Local examination: 2 openings at 3’o’clock and 5’o’clock positions 

Prescription
On 29 /3/07 Kali Carbonicum LM 1 BD

Analysis & Discussion
The most striking feature was his insecurity which was evident in his inability to blend with people and make friends and his habit of nail biting. As he grew up in an unhealthy family atmosphere without his father’s affection, he became extremely sensitive and short tempered (touchiness).

His high-headedness and argumentative nature was just a mask to cover his indwelling insecurities.

Kali carb was the drug of choice as it covered his entire persona- his sensitiveness; his insecurities; his desire for sweets; being ticklish and tendency to sweat freely.

Follow up

  • Pricking pain felt along with burning during later part of defecation but much better than before.
  • Discharge occasional and watery now. Very slight itching now.
  • Bleeding very occasional.
  • App: good; Bowels: normal 

Over a period of 5 months he received Kali carb LM 1 – LM  8 B.D. and Kali carb LM 9- LM  11 O.D. and recovered completely. He has been without any medication for last 18 months and has also referred to us 3 more cases fistula-in-ano.

Dr Gyandas G Wadhwani
Sr Medical Officer (Homoeopathy), ISM & Homoeopathy, Ministry of Health & Family Welfare, Govt. of NCT Delhi. India.
Email: homoeopathygyan@gmail.com

Comments

25 Responses so far.

  1. rakhi singh says:

    my brother is having a complain of pilonidal sinus, since last 5yrs in the loin region.he has taken allopathic and homeopthic traetment,now he is taking homeopathic medication.myself his elder sister pursuing BHMS,prescribed him HEPAR SULPH 2OO…his discharges is reduced.
    whenever he ride bike or travel in train or vehicle for 2-3 hours for 2-3 days regularly…then his complaints get aggravated…with discharge of blood stained pus and then it get subsided

    • ALOK AGRAWAL says:

      I have been suffering from fistula in ano for the past several year and would like to take proper homeopathy treatment for curing the same. The general precautions like fibre food, lots of liquid and laxatives to soften the stools are being taken.

      Would like to take your advice and homeopathy treatment for curing this once and for all.

  2. Parth Sarthi says:

    Hi
    I am suffering form anal fistula for last 7 month.it’s external opening is at 9’0 clock, & no due in anal canal on fistulogram, according to doctor my fistula tract is not too mature & he advised for surgery after 3 month, but some internal pain & discharge pus after every 15 days. i want to know have any medicine in homeopath to 100 % cure for anal fistula ?
    Thanks

  3. Hari Rawat says:

    Sir,
    I am sufferring from high fistula in ano for last 24 years and has operated surgically twice in the year 1988 and 96. Now I again having recurrence of the disease with lot of pain and discharge.
    Kindly let me know the treatment in homeopathy
    Yours
    Hari Rawat

  4. Raja says:

    sir, i am suffring from fetula from 1.5 years.. i wanna know that is there any parmanent care in homeopathy? if yes then reply me with detail…

  5. Anup says:

    sir,
    i am suffring from fetula from last 5 months and I am 27 years old.. Even though my surgery also done but again its recurrence.
    i wanna know that is there any parmanent care in homeopathy? if yes then reply me with detail…
    Its very urgent sir .. Pleasee

  6. sir mjhe fastula ke taklef he twoyear se mein jb baht bethita ho to baht pain hota he and build be atta he plz plz sir mjhe treatment de i live in pakistan plz sir reply karna i wait ur answer plz thanks

  7. ps reddy says:

    Sir,

    I am suffering with fistula in ano, I am using homeo medicians since 7 years with the help of the physicians I used the Sil, Cl.Phos. etc. But no use please give any curable medicine.

  8. rajesh goel says:

    fistula in ano last four year.pus discharge sometime red pus discharge.itching regular homeopathy medicine use but not cure.request for your suggetion

  9. deepak says:

    dear sir,

    suffering from fistula in ano age 43 yrs ,pl suggest /advice treatment .
    thanks,
    deepak

  10. NITIN KUMAR says:

    Sir,
    I am suffering with high fistuka in ano. trak is 3-4 cm pless give me right way.pless send u contact number.

  11. karan says:

    I have fistula in anus from last 4 years(march 2009), I am taking homeopathic medicines from last 4 years. I have shown it to various homeopathic doctors and till date I have taken hepar sulph, paeonia, sulphar, calcerea carb, myristica sebifera30, calc flora, bryonia, silicea30. All these medicines collectively have given me relief, but not cured me permanently. At starting (in 2009) I had only one opening and path but now I can feel two paths are made (first path is at 4am and other path is down wards to pelvis 6am ) and three new openings (new openings are on the same side of first opening). Presently I am taking silicea 200 from last 2 months but it also has not cured me completely. My hairs density on body and scalp is reduced moreover lot of bone marrow is also reduced after taking silicea. Is there any permanent cure in homeopathy for fistula.

  12. yogeswar nayyar says:

    Hi
    I am 25 years old suffering form anal fistula for last 3 months.it’s external opening and no due in anal canal on fistulogram, according to doctor my fistula tract is not too mature & he advised for surgery after 2 months, I have pain & discharge pus and blood since 3 months. I am unable to sit. i want to know have any medicine in homeopath to 100 % cure for anal fistula ?
    Thanks

  13. tarun kumar majumder says:

    I’m 43+ Male, Indian, suffering from Fistula in ano since November 2008. It occurs 8 to 10 times in a year with pain nearby rectum (skin becomes swallo and discharge of pus with blood). I cant control / cure it through alopathy medicine and as per doctor, it should be operate (surgery) only.
    My father was a patient of the same also (in our family). Apart from this I’m also a patient of gastritis and taking Isobgul regularly for easy bowel movement. I also take 3 to 4 litre of water regularly. Chewing Tobaco was a habit of mine for last five years but now I have stopped it. Please advise me and save my life from this kind of irritation and oblige. Best regards.
    T.k.Majumder

  14. ramesh says:

    Dear Dr. my name is ramesh age is 35 married, sir
    now iam suffering with anal fistula, and my lymph gland swelled at armpit since six months, now growth but some times inconvenience at my armpit place. in previous ihave consticipation, and high gas problme, and 5 years back i traced diabetes but that time i used homeo till normal so please give me good suggestion sir

  15. sandip says:

    Dear Dr.

    I have been suffering from Anal Fissure since 4-5 years and I am taking Homeopathy Medicine like Asuculus Pentarkan, Calendula, Ratania-200 etc. I have been taking these medicines since 2 years. Since last 1 months I am feeling severe pain and burning sensation in the anal region. Please suggest medicine.

  16. s k sharma says:

    Respected sir, i am suffering from anal fistula from the last three yearsbut it was agrevated six months ago when i got ulcerous colitis.now Dr don’t want to operate due to colitis ,he advised me to have a glue injection.Pl guide me if i should go for the injection or not,also suggest me if it can be cured with homeopathy medicine. satish sharma chandigarh

  17. Naresh Kondala says:

    Hello Doctor,

    This is Naresh from India (Andhra Pradesh) 30 years old. I am also facing with fistula problem from last year on words. Please help me to get out of this situation. If you give your address or personal mail address, then I will meet you/mail you and explain my problem in detail.

    Regards,
    Naresh

  18. loknath maharana says:

    Hi,
    i recently undergone a operation for anal fistula wherein the doctors have exercised a part of my gluetal area to remove the fistula track. unfortunately the problem still persists, and inspite of the wound healed to about 80% the puss discharge is still continuous and persistent. i just wanted to know if you have any homeopathy treatment for my fistula if so how is it done, how much time does the procedure takes and whats are the cost estimate.

  19. hello doctor
    This is shambhu nath mishra 84 years old. I have been suffering from anal fistula from last 6 months . i have pain (some time) discharging of pus and iching . plij suggest me any medicine to cure it completely .

  20. Respected sir; I am suffering fistula last 2 year and taking homeopathic medicine last 1 year but not completely cover this decease so please tell me how to cover this.

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